Dear DOCTOR Owen:

I weigh 230 pounds, have a chronic back condition, and was told by my orthopedist and chiropractor to lose weight. I weighed 130 pounds when I got married and I know my husband would be happy if I could get to that weight again. What type of diet program is best for this much weight loss?

Aching Back

Dear “Aching”:

The most important first thing to do when embarking on a weight-reduction strategy (or any goal strategy for that matter) is to identify the true goal, set a time to reach that goal, list the obstacles, identify the people and groups necessary to help or hurt in meeting that goal, and then get started.

In your question, the two goals you identify have nothing to do with your goal to weigh 130 pounds. Your back pain may be alleviated with as little as a 10% weight loss and very properly instructed exercise (physical therapy). In fact, 20% loss, or 50 pounds in your case, will resolve most medical conditions caused, or contributed, by obesity and diet. Thus, the goal for your back condition—from my perspective—is to diet down to 180 pounds.

As for your husband: Have you discussed your goal with him? I’m sure he’d be happy if you weighed 130 pounds again. But how much does he care about that weight and, more importantly, how much is he willing to sacrifice and help you in your quest? My experience is that most spouses are initially supportive. Then the bills for the diet program start arriving; you start to avoid social gatherings, in an attempt to stay focused; your children (if applicable) whine with fast food deprivation syndrome; their favorite snacks are no longer kept around the house. Now how supportive is your honey?

No matter how great the support system, the pressure to stop you in your pursuit will mount: “Oh, you can have just one!” (and so can I). “Aw, Mom, let’s get pizza” (and prove you love me). “You’re looking too thin and need to stop that diet” (or you’ll look better than I do). Be on the lookout for people to derail your efforts because it affects them.

In Primary Psychiatry, Vol. 5, No. 10, Dr. Thomas Wadden, one of the world’s leading researchers on the behavioral aspects of obesity, reviews what most people view as success in a diet program. In every one of his studies of dieters, Dr. Wadden finds that patients’ goals are not realistic.

For example, patients were asked to identify a “dream” weight, a “happy” weight, an “acceptable” weight, and a “disappointed” weight. To reach “acceptable,” most of them would have had to lose 25% of their current weight, and lose 38% of their current weight to reach their “dream” weight.

A “first-class” Diet Therapy program will average 12% weight loss. While this sounds disappointing, most health problems will be markedly improved by just this amount of weight loss. More important than the immediate goals of a specific weight, relief of pain, or acceptance are the changes you will make to attain your goals. For example, do you exercise regularly and properly? Are the changes in the household and social environment sustainable and incorporated by everyone who lives there? Do you have a daily top-priority plan that doesn’t get pushed aside for “if I have time” excuses? Has your diet program helped you identify why you gained the weight, and does it teach you the knowledge and skills you need to manage food, exercise, and other people?

Will you feel like a failure at 180 pounds or a great success? That depends on realistic, do-able goals. While everyone wants to be a millionaire or a billionaire, the path to amassing that fortune is rarely via winning Lotto. Rather, such fortunes are stockpiled by having a good knowledge and skill base; a written business plan; and lots of support, time, patience, and persistence. And when do you know if that is enough? How you measure success is also how you measure failure.

My advice is to achieve your first goal. Get down to 180 pounds and focus on your back condition. Measure and reward your success when you achieve that goal, and ask your husband to help with the reward! Then set your next goal.